Mid-diastolic murmur

Mid diastolic murmurs:

• mitral stenosis - maximal at the apex with the patient inclined to the left. The murmur begins after the opening snap. The murmur is long if severe and short if mild.
• tricuspid stenosis - maximal at the lower left sternal edge. The murmur is increased by inspiration.
• a murmur mimicking mitral stenosis may occur when there is greatly increased flow across the mitral valve. This may occur in mitral regurgitation, VSD, patent ductus, or, a hyperdynamic circulation e.g. thyrotoxicosis.